Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.1/15454 |
Resumo: | Background: Sympathetic dysfunction can be evaluated by heart rate reserve (HRR) with exercise test. Objectives: To determine the value of HRR in predicting outcome of patients with hypertrophic cardiomyopathy (HCM). Methods: We enrolled 917 HCM patients (age = 49 +/- 15 years, 516 men) assessed with exercise stress echocardiography (ESE) in 11 centres. ESE modality was semi-supine bicycle in 51 patients (6%), upright bicycle in 476 (52%), and treadmill in 390 (42%). During ESE, we assessed left ventricular outflow tract obstruction (LVOTO), stress-induced new regional wall motion abnormalities (RWMA), and HRR (peak/rest heart rate, HR). By selection, all patients completed the follow-up. Mortality was the predetermined outcome measure Results: During ESE, RWMA occurred in 22 patients (2.4%) and LVOTO (>= 50 mmHg) in 281 (30.4%). HRR was 1.90 +/- 0.40 (lowest quartile <= 1.61, highest quartile > 2.13). Higher resting heart rate (odds ratio 1.027, 95% CI: 1.018-1.036, p < 0.001), older age (odds ratio 1.021, 95% CI: 1.009-1.033, p < 0.001), lower exercise tolerance (mets, odds ratio 0.761, 95% CI: 0.708-0.817, p < 0.001) and resting LVOTO (odds ratio 1.504, 95% CI: 1.043-2.170, p = 0.029) predicted a reduced HRR. During a median follow-up of 89 months (interquartile range: 36-145 months), 90 all-cause deaths occurred. At multivariable analysis, lowest quartile HRR (Hazard ratio 2.354, 95% CI 1.116-4.968 p = 0.025) and RWMA (Hazard ratio 3.279, 95% CI 1.441-7.461 p = 0.004) independently predicted death, in addition to age (Hazard ratio 1.064, 95% CI 1.043-1.085 p < 0.001) and maximal wall thickness (Hazard ratio 1.081, 95% CI 1.037-1.128, p < 0.001). Conclusions: A blunted HRR during ESE predicts survival independently of RWMA in HCM patients. |
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Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathyAutonomic dysfunctionStress echocardiographyHypertrophic cardiomyopathyBackground: Sympathetic dysfunction can be evaluated by heart rate reserve (HRR) with exercise test. Objectives: To determine the value of HRR in predicting outcome of patients with hypertrophic cardiomyopathy (HCM). Methods: We enrolled 917 HCM patients (age = 49 +/- 15 years, 516 men) assessed with exercise stress echocardiography (ESE) in 11 centres. ESE modality was semi-supine bicycle in 51 patients (6%), upright bicycle in 476 (52%), and treadmill in 390 (42%). During ESE, we assessed left ventricular outflow tract obstruction (LVOTO), stress-induced new regional wall motion abnormalities (RWMA), and HRR (peak/rest heart rate, HR). By selection, all patients completed the follow-up. Mortality was the predetermined outcome measure Results: During ESE, RWMA occurred in 22 patients (2.4%) and LVOTO (>= 50 mmHg) in 281 (30.4%). HRR was 1.90 +/- 0.40 (lowest quartile <= 1.61, highest quartile > 2.13). Higher resting heart rate (odds ratio 1.027, 95% CI: 1.018-1.036, p < 0.001), older age (odds ratio 1.021, 95% CI: 1.009-1.033, p < 0.001), lower exercise tolerance (mets, odds ratio 0.761, 95% CI: 0.708-0.817, p < 0.001) and resting LVOTO (odds ratio 1.504, 95% CI: 1.043-2.170, p = 0.029) predicted a reduced HRR. During a median follow-up of 89 months (interquartile range: 36-145 months), 90 all-cause deaths occurred. At multivariable analysis, lowest quartile HRR (Hazard ratio 2.354, 95% CI 1.116-4.968 p = 0.025) and RWMA (Hazard ratio 3.279, 95% CI 1.441-7.461 p = 0.004) independently predicted death, in addition to age (Hazard ratio 1.064, 95% CI 1.043-1.085 p < 0.001) and maximal wall thickness (Hazard ratio 1.081, 95% CI 1.037-1.128, p < 0.001). Conclusions: A blunted HRR during ESE predicts survival independently of RWMA in HCM patients.MDPISapientiaCiampi, QuirinoOlivotto, IacopoPeteiro, JesusD’Alfonso, MariaMori, FabioTassetti, LuigiMilazzo, AlessandraMonserrat, LorenzoFernandez, XustoPálinkás, AttilaPálinkás, EszterSepp, RóbertRe, FedericaCortigiani, LauroTesic, MiloradDjordjevic-Dikic, AnaBeleslin, BrankoLosi, MariangelaCanciello, GraziaBetocchi, SandroLopes, LuisCruz, InesCotrim, CarlosTorres, MarcoBellagamba, ClarissaVan De Heyning, CarolineVarga, AlbertÁgoston, GergelyVillari, BrunoLorenzoni, ValentinaCarpeggiani, ClaraPicano, Eugenio2021-04-27T17:43:05Z20212021-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.1/15454eng2077-038310.3390/jcm10071347info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-07-24T10:27:52Zoai:sapientia.ualg.pt:10400.1/15454Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:06:16.883532Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy |
title |
Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy |
spellingShingle |
Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy Ciampi, Quirino Autonomic dysfunction Stress echocardiography Hypertrophic cardiomyopathy |
title_short |
Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy |
title_full |
Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy |
title_fullStr |
Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy |
title_full_unstemmed |
Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy |
title_sort |
Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy |
author |
Ciampi, Quirino |
author_facet |
Ciampi, Quirino Olivotto, Iacopo Peteiro, Jesus D’Alfonso, Maria Mori, Fabio Tassetti, Luigi Milazzo, Alessandra Monserrat, Lorenzo Fernandez, Xusto Pálinkás, Attila Pálinkás, Eszter Sepp, Róbert Re, Federica Cortigiani, Lauro Tesic, Milorad Djordjevic-Dikic, Ana Beleslin, Branko Losi, Mariangela Canciello, Grazia Betocchi, Sandro Lopes, Luis Cruz, Ines Cotrim, Carlos Torres, Marco Bellagamba, Clarissa Van De Heyning, Caroline Varga, Albert Ágoston, Gergely Villari, Bruno Lorenzoni, Valentina Carpeggiani, Clara Picano, Eugenio |
author_role |
author |
author2 |
Olivotto, Iacopo Peteiro, Jesus D’Alfonso, Maria Mori, Fabio Tassetti, Luigi Milazzo, Alessandra Monserrat, Lorenzo Fernandez, Xusto Pálinkás, Attila Pálinkás, Eszter Sepp, Róbert Re, Federica Cortigiani, Lauro Tesic, Milorad Djordjevic-Dikic, Ana Beleslin, Branko Losi, Mariangela Canciello, Grazia Betocchi, Sandro Lopes, Luis Cruz, Ines Cotrim, Carlos Torres, Marco Bellagamba, Clarissa Van De Heyning, Caroline Varga, Albert Ágoston, Gergely Villari, Bruno Lorenzoni, Valentina Carpeggiani, Clara Picano, Eugenio |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Sapientia |
dc.contributor.author.fl_str_mv |
Ciampi, Quirino Olivotto, Iacopo Peteiro, Jesus D’Alfonso, Maria Mori, Fabio Tassetti, Luigi Milazzo, Alessandra Monserrat, Lorenzo Fernandez, Xusto Pálinkás, Attila Pálinkás, Eszter Sepp, Róbert Re, Federica Cortigiani, Lauro Tesic, Milorad Djordjevic-Dikic, Ana Beleslin, Branko Losi, Mariangela Canciello, Grazia Betocchi, Sandro Lopes, Luis Cruz, Ines Cotrim, Carlos Torres, Marco Bellagamba, Clarissa Van De Heyning, Caroline Varga, Albert Ágoston, Gergely Villari, Bruno Lorenzoni, Valentina Carpeggiani, Clara Picano, Eugenio |
dc.subject.por.fl_str_mv |
Autonomic dysfunction Stress echocardiography Hypertrophic cardiomyopathy |
topic |
Autonomic dysfunction Stress echocardiography Hypertrophic cardiomyopathy |
description |
Background: Sympathetic dysfunction can be evaluated by heart rate reserve (HRR) with exercise test. Objectives: To determine the value of HRR in predicting outcome of patients with hypertrophic cardiomyopathy (HCM). Methods: We enrolled 917 HCM patients (age = 49 +/- 15 years, 516 men) assessed with exercise stress echocardiography (ESE) in 11 centres. ESE modality was semi-supine bicycle in 51 patients (6%), upright bicycle in 476 (52%), and treadmill in 390 (42%). During ESE, we assessed left ventricular outflow tract obstruction (LVOTO), stress-induced new regional wall motion abnormalities (RWMA), and HRR (peak/rest heart rate, HR). By selection, all patients completed the follow-up. Mortality was the predetermined outcome measure Results: During ESE, RWMA occurred in 22 patients (2.4%) and LVOTO (>= 50 mmHg) in 281 (30.4%). HRR was 1.90 +/- 0.40 (lowest quartile <= 1.61, highest quartile > 2.13). Higher resting heart rate (odds ratio 1.027, 95% CI: 1.018-1.036, p < 0.001), older age (odds ratio 1.021, 95% CI: 1.009-1.033, p < 0.001), lower exercise tolerance (mets, odds ratio 0.761, 95% CI: 0.708-0.817, p < 0.001) and resting LVOTO (odds ratio 1.504, 95% CI: 1.043-2.170, p = 0.029) predicted a reduced HRR. During a median follow-up of 89 months (interquartile range: 36-145 months), 90 all-cause deaths occurred. At multivariable analysis, lowest quartile HRR (Hazard ratio 2.354, 95% CI 1.116-4.968 p = 0.025) and RWMA (Hazard ratio 3.279, 95% CI 1.441-7.461 p = 0.004) independently predicted death, in addition to age (Hazard ratio 1.064, 95% CI 1.043-1.085 p < 0.001) and maximal wall thickness (Hazard ratio 1.081, 95% CI 1.037-1.128, p < 0.001). Conclusions: A blunted HRR during ESE predicts survival independently of RWMA in HCM patients. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-04-27T17:43:05Z 2021 2021-01-01T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.1/15454 |
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http://hdl.handle.net/10400.1/15454 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
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2077-0383 10.3390/jcm10071347 |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
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MDPI |
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MDPI |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799133303671881728 |